 Good afternoon, and thank you all for joining us. I'm Steve Morrison from CSIS, and I want to welcome you all This event the tweet for this is a hash sign women global health G H women G H We're going to open with a video of President Bonda from Malawi And I'll offer a few opening remarks and then following that I will introduce Secretary Sebelius Who will deliver the keynote address here and then thereafter? We will have a another video and then move towards a panel discussion led by Janet Fleischman We're really thrilled that on the eve here of International Women's Day That we were able to bring together Secretary Sebelius Christie Turlington burns Christy Micas from the US government the PEPFAR coordinator in Zambia Kay Warren from Saddleback Church Dr. Phil Nyberg Who's worked with us over the last decade to talk about the different dimensions of the challenges here as we look forward on? women's health issues We've just released a major report That I hope you will all have had a chance to grab the chapter we reproduced Many copies of Janet Fleischman's chapter on women's health for you today That broader volume is also available online and we've handed out a small placard that gives you instructions on how to to access that We started that effort back in the fall with the view that in the in the first Obama term There had been an enormous number of new policy initiatives and thinking and and and it had been a period of great ferment and an activity By leaders like Niels de Lair here Thank You Niels for joining us and for making Making it with us today and helping us make this event possible We were trying to digest across multiple sectors the policies and and programs that had and approaches that had been launched in the first term And what had been the the impacts and the lessons learned and what were likely to be the recommended courses of action With respect to these different areas HIV AIDS Malaria Polio women's health we took a special look at multilateral institutions and international health diplomacy I hope you'll all enjoy that and make good use of that We have Had and placed an enormous priority over the last Several years on women's health and it's Janet Fleischman's leadership here at CSIS. It's been most fundamental to that effort we started a long time back in Over a year ago in working collaboratively with the US Embassy in Zambia to dive into a number of issues and And most recent and and we're very grateful to Mark Sterella ambassador Sterella and his team for all of the support We'll be going back there again in another two weeks with a delegation to look at three core dimensions of women's health and Along with a number of key congressional staff and some of our own personnel This is very important to us and it's something that we feel great pride in in carrying forward And I think it is it's really a sign of how vitally important all of these issues have become to us that all of you are here today To join us in this in this effort So we're going to have three short videos that will intersperse through the program that really are these are the voices of African women and men African women and African women leaders talking about the different dimensions of this agenda. We're gonna start with With president Bonda, I want to recognize the ambassador to Malawi his Excellency ambassador Stephen Matenjay ambassador Thank you so much for joining us today and all of your all of your support I also want to record recognize Zambian Embassy representatives Ben Kangua and Patricia Latia Ben are you here Ben? Thank you so much. You've been very supportive of our efforts over a long period of time So with that, why don't we move to? To to our first video. I need to first say though Julia Nagel who's with us here today Julia. Could you stand up, please? Julia Nagel was was with us as our social media and video expert for two and a half years and has Moved to Voxiva to do some additional work in his but is retaining a strong link to us And has been really vitally important in pioneering the work that we've done in video over the last two years and Julia I just want to sing you out for the the extraordinary effort and contribution that you've made to us and what you're going to see here over The course of the next two hours and the three videos is very much The the product of your incredible commitment to bringing this all forward along with Janet and the many other people here that That we will talk about so why don't we tee up our first video? We'll go through that's about five minutes, and then I'll introduce the secretary and we'll hear from our keynote speaker. Thank you very much My mission in life is to assist women and youth gain social and political empowerment through business and education because It is only when a woman is economically empowered that she begins to make critical decisions about her health Especially at household level I have found in the many years of working with women That it is when a woman is economically empowered that she can negotiate At household level with her husband about the number of children that body of hers can have So we are tackling the provision of family planning devices Secondly, we find that most women that die die giving birth and I think as a woman leader That's not acceptable. It is not possible for me to sit back and watch 690 women die out of every 100,000 giving life That's not acceptable. I've grown up in a society where When a woman is pregnant the whole village is anxious I don't think as a country we have any choice and I'm grateful to the government of the United States of America Because they are the ones who are helping us in the Providing treatment pregnant women so that they don't pass on the virus to the child So we see now a whole generation of children being born age-free because The mother has received precautionary treatment while she was pregnant What breaks my heart is the fact that when you if we see women that are dying the 690 Most of them are between 15 and 19 So the reason is they are not going to secondary school. They are not going to secondary school because it's not free So when she cannot afford the 50 dollars She drops out and then the community encourages her to get married and because her body is not ready for Childbirth there are the ones that are dying. That's why I'm sending 2300 girls to school because I just believe that keeping a girl in school for more years Is not about just about her future. It's about her health You know when a woman gets into state house They notice the little things that would otherwise be ignored by man Issues of family planning issues of maternal mortality issues of man Issues of the well-being of the household Therefore to protect the woman to provide a good life for her to provide health for her to provide education for the Girl child is is a must It is unfortunate that I get into office when this country country's economy was completely Destroyed through greed mismanagement and corruption. It is extremely important to stay the course Because it is tempting sometimes when you have elections in 15 months time You are tempted to say well, let's let's fix the culture our currency Let's let's let's back track for the purposes of the elections But I have told myself that I have never let down my people and while I'm trying to bring the country back on track I'm also very mindful of my mission to make sure that I continue to empower women I continue to assure that we have access to family planning devices They have our access to economic empowerment opportunities because for me It is when you see a woman move from where she didn't know her next meal To a point where she begins to even get respect and begin to make decisions at household level because of the economic Contributions is making for me that is power. So for me, that's what it being a leader is all about Thank you very much Our next speaker is our first our keynote speakers secretary Kathleen Sebelius who's been a secretary of health and human services since April of 2009 We're very very fortunate that she has chosen to stay on in that position in this critical second term When the Affordable Care Act becomes reality in so many new and and vitally important in profound ways She prior to becoming secretary served as governor of Kansas 2003 to 2009 Served as the insurance commissioner prior to that in her tenure during the first term the HHS the department issued its first-ever strategy on global health Which was a very important effort at tying together the many different Strings of effort and expertise and engagement that the department encompasses into a much more coherent single strategy in that period Nils de laire's office of global affairs was elevated to assistant secretary rank a very important and long overdue change And congratulations Nils and I might say also in our In the in the volume that we've shared with you when you look at the Section on multilaterals and you look at the work on WHO and some of the other some of the other multilateral institutions One theme that jumps out is the degree to which under Nils leadership The tone the tenor and the quality of our dialogue in Geneva and many other key places has improved Dramatically, and it's borne us very significant concrete Concrete gains in terms of negotiated negotiated progress on some very important matters in global health So I think we're making great progress and secretary. Thank you so much for for being here with us today Well, good afternoon everybody, and I am delighted to have a chance to be here today Thank you Steve for that kind introduction for your leadership of the center and for Convening this really important discussion. I want to join you in Acknowledging how much dr. Nils de laire has not only expanded and improve the Global reach of the United States in health work around the world, but also is active in a whole variety of strategic initiatives on behalf of health and human services and I'm really pleased to be here today to speak About a top priority for the Obama administration and certainly to me personally one that I've worked on for a very long time And that's the health of women and girls and not only in this country, but around the world I was able to visit Programs in East Africa in 2011 and one of the things that struck me and President Banda just referred to that but is the strength and resilience of women that I met there And I want to just tell you about one amazing woman, which still kind of sticks out of my mind in rural Kenya I met a woman who is HIV positive named Jemima and at one point the effects of her illness were so bad that she had wasted down to about 77 pounds and When she was in that near death state a volunteer brought Jemima and her family to a health clinic that was supported by US government investments Now she went home with what's known as a basic care package Which was a bundle of low-cost health interventions that have been developed by researchers from CDC's global AIDS program and it was Designed to prevent some of the most debilitating infections among people living with HIV and before long that Basic health package was really having an impact Jemima Bounced back she regained her healthy weight and she recovered strength to live and work again But she didn't stop by just getting back her own health She became a health leader in her community. She founded a group that Offers emotional and financial support to those families Affected by HIV she sells health products to help support eight sick and orphaned children that she has adopted And she's referred now more than a hundred HIV infected men women and children to the same facility where she got help So investing in Jemima had an incredible ripple effect We didn't just save her life or her family's life We gave the community an amazing leader an entrepreneur and a lifetime advocate for health So when the president made women's health a major focus in his global health initiative It wasn't just about closing the huge gender disparities and access to care and treatment And that is very significant and very important closing those gaps But it's about recognizing the truth that Jemima story exemplifies When we invest in the health of women and girls it doesn't just improve the health outcomes for those individuals it produces benefits that ripple through families through communities through nations and It creates enormous returns in economic growth in poverty reduction and in overall development No investment in this country I would say or around the world has a bigger payoff than investing in women's health and thanks to the president's leadership and the amazing leadership of former state secretary Hillary Clinton and lots of other dedicated officials throughout the Administration we have made some incredible progress over the last four years Now take HIV for example, which for many years was considered primarily to be a men's health issue Today we know an unfortunate truth women and girls make up more than half of the world's HIV infected population more than half and HIV is now the leading cause of death for women of reproductive age worldwide So that Knowledge has bolstered initiatives like PEPFAR and put a new focus on reaching women whose lives are touched by the global HIV crisis in the first half of this fiscal year We've already reached more than 370,000 women with treatment Putting us on track to reach PEPFAR's target of an additional 1.5 million women in treatment by 2014 And we've also elevated global health to the forefront of our foreign policy Through the development of new initiatives like USAID's gender equality and female empowerment policy Through new appointments including the first-ever ambassador for global women's issues Milan, Vavir and we've created Impressive new partnerships that have led to historic levels of global investment in family planning services cervical and breast cancer screenings and the prevention of sexual violence and I know on the panel that Follows me today. You're going to hear from a number of people who are either doing on the ground Incredibly important work or are part of that really strategic partnership across the globe Now those Accomplishments clearly are not the administration's accomplishments alone the support of many domestic and international partners including as I said lots of folks represented here today in this room and the engagement of foreign governments has been essential to making progress and We intend to continue to build on those partnerships in the years ahead because for all the great work that has been done There is way more to do Now one area we know we need to do more is HIV prevention for mothers and children and again You just heard president bond to talk about it We are making progress on ending mother-to-child HIV transmission by providing enter retro viral treatment to infected mothers And we just had I'm sure all of you saw a breakthrough moment recently where the scientists at NIH Were really heartened by the recent news that the aggressive Aniretroviral treatment in a Mississippi young Newborn may have completely removed the virus from her body. That's an amazing step forward And while we're not yet ready to declare this is a path to curing AIDS It it was a breakthrough that will be followed very closely We're also continuing to work to reduce the social barriers that prevent women from getting the care they need as More women receive treatment and return to health the stigma surrounding HIV is melting away community by community family by family Increasing the willingness of more women to be tested, but we have a long way to go I was in a clinic in India and listened to the workers talk about the issue that if a woman gets treated and is HIV positive often she is then drummed out of the family unit made to leave her home Even if the husband was the originator of the infection he is protected and cherished and she is seen as Someone who has brought the disease and shame on the family So there is still a huge issue about testing and treatment that we need to deal with But what we know is that if we can break down those barriers It creates a positive cycle of awareness and treatment and one again that strengthens local economies Protects children from becoming orphans and brings us closer to achieving what I think is a universal goal of an AIDS-free Generation that really is on the horizon Now a second cornerstone of the work. We're doing will be reducing maternal mortality around the world Every day each and every day about 800 women die during childbirth More than one woman every two minutes and when a mother dies What we know is her child is seven times more likely to die within the first 12 months even if they survived the birth Those risks are even greater in the developing world Where three out of every four women in need of care for complications from pregnancy don't receive it three out of four and Even in the places where care is available the demand is so great that it stretches resources to their limits. I Was in a maternity ward in Zanzibar in 2011 There were so few beds in this maternity ward that women were sharing beds in a postnatal room having just given birth to babies There was very little blood supply So relatives were in the courtyard Waiting to see if there was a pregnancy complication so they could indeed be called upon To give blood and those were just the women who made it to the birthing center The hospital was doing heroic work in face of nearly impossible conditions but even so a heartbreaking number of women weren't getting the care they needed Through new international public-private partnerships like saving mothers giving life We're working to change that By providing mothers with essential care and resources that they need during labor Delivery in the first 24 hours after birth We're aiming to reduce maternal mortality rates by 50 percent in targeted countries in Zambia and Uganda that work is already underway a Third area of ongoing focus is the work to reduce gender-based violence Now here in the US we have a major milestone going on right now as I speak to you With the president signing the reauthorization of the Violence Against Women Act And I was actually with the president at a meeting this morning and he said I'll see you later at the signing I said no, I'm standing you up because I'm talking to a really important group about worldwide reach on women's health But we know that Around the world many women face even greater risk for domestic and interpersonal violence And that's why in the second term we'll be implementing the first-ever US strategy To prevent and respond to gender-based violence globally and it provides Concrete action to support vulnerable women and girls through the State Department and USAID Now we all can be proud of the progress that's been made over the past four years Thanks to hard work and efforts of dedicated partners at home and abroad We've been able to put some important policies in place We've gotten some effective programs off the ground But now is the time that we must ensure that the groundwork is turned into real results for women and girls everywhere As we move forward it's been particularly heartening to me to see a wave of women moving into global health leadership around the world Here in the Americas with our neighbors 14 of our hemispheres health ministers Including my good partners in Canada and Mexico are women as is our newly elected Pan-American Health Organization regional director Dr. Carissa Aitian in Africa eight health ministers are women as is the new chair of the African Union Dr. Delamy Zuma who I met with just last week and of course the World Health Organization is led by Margaret Chan Again a woman I've had the opportunity to know these remarkable women But as President Banda said so well women bring their life experience to the table having these Expanded number of women serving as presidents of countries as health leaders as ministers as leaders in the World Health Organization Means that the issues around the health of women and girls are not going to disappear from the agenda anytime soon These women bring with them their own deep commitment to the health and well-being of girls and women as We continue the fight for women's health across the globe We can't forget that ensuring equality in health has to again start here at home Now from his first days in office and as Steve said through the passage of the Affordable Care Act The president has made women's health a centerpiece of his domestic agenda Because of the law insurers will in the very near future Be forbidden from charging women higher premiums just because of their gender Being a woman as I like to say will no longer be a pre-existing condition in America that practice will be gone for good And we're also ending finally what has been a ridiculous double standard in way too many plans Where Viagra is treated like an essential medication and birth control like a luxury product Because of the new law tens of millions of women Can now walk into their doctor's office and get contraceptive care and other critical preventive services Without co-pays or co-insurance taking down a huge financial barrier and When the new health marketplace is open for enrollment in October every plan Will be required to cover prenatal and maternity care a welcome change from today's market Where that kind of comprehensive coverage is the exception and not the rule for far too many insurance policies that women deal with So women of all ages are actually great beneficiaries of the Affordable Care Act Young women under 26 are eligible for coverage on their parents plans working women Who are less likely to receive insurance through their employers are gaining greater access to affordable options Older women who make up the majority of Medicare enrollees are seeing the quality of their care go up and costs go down So we are going to spend the next term building on that progress here in abroad and Although some of the faces in the administration may change This guiding principle never will That no woman anywhere should be denied the care and support she needs to live a healthy life and take care of herself and her children That's a message. You're going to keep hearing from this administration during the second term With your help with those of you in this room and the organizations Entities you represent We have the opportunity over the next four years to touch millions more lives and improve the welfare of countless communities It's our responsibility to use the time we have to see that mission through and I look forward to working with all of you Toward that shared goal. Thank you very much Again, thank you all for coming before we turn to the next panel We'd like to show you our latest video which is focusing exactly on some of the issues that Secretary Sebelius was Referring to And a new initiative to address it called saving mothers giving life This is the premiere of this video. You may have seen the others, but this one is just first being shown today We looked at more maternal mortality because every day Nearly 800 women die from complications of pregnancy and childbirth around the world and 99% of these occur in developing countries These deaths are largely preventable with interventions and training to prevent or treat complications such as hemorrhage infection obstructed labor and with increased access to reproductive health and emergency care This video explores the challenges and opportunities to address these issues in Zambia a country with disproportionately high maternal mortality The saving mothers giving life initiative a public-private partnership strongly supported by the u.s. Government aims to reduce maternal mortality by up to 50% in selected districts of Zambia and Uganda The voices of these women in Zambia remind us that effectively addressing maternal mortality in Zambia and elsewhere Will demand ongoing commitments and investments from national governments international partners and community-based groups So once again, let me thank the Zambian government for allowing us to film at these sites to make the video You'll the videos you'll see today The Zambian health care workers and women who helped us understand the realities of maternal mortality in their country The Hewlett Foundation for their generous support that allowed us to make these videos the extraordinary CSIS video team that Traveled with me to Zambia and Malawi Chris LaTendra for his wonderful camera work and Julia Nagel for her masterful ability to translate these complicated realities into such a visually compelling product and finally to Steve Morrison who's support for the work on women's health and women's global health and whose leadership and vision has made this work possible So if we cue the lights In Zambia when women have delivered we say oh you have survived We continue to have a very high mortality in Zambia. Our women die before labor during labor and after labor and one of the challenges has been that less than 50% of women Can access skewed delivery A lot of women are not accessing the health care services on time Because we have a lot of women living in far Away places away from the hospital. So by the time they reach here it would have been too late for them Yes at the facet levels so there are delays In the past when the woman got to the facility One of the issues to do with equipment may not be readily available Even the actual drugs needed for them to attend to the lady may not be readily available at that point So they would come to the clinic. They would come to the facility But then they will not be able to get a service that they need most where do women die They die soon after delivery. So you see why skewed deliveries Is of utter most important What we are doing in the seven mothers giving lives really hinges on reducing those delays And so we have a system at the community level. We have introduced a structure of the Safe motherhood action groups. These are mothers and the fathers that are serving in the community And we train them we provide a basic training so that mothers are easier than fired early enough And encouraged to go to health for children to seek services for the well-being of the mother and the well-being of the child the us government Put funds for us to be used in four districts so that we can in those four districts Reduce mortality by 50 percent By using well-known interventions treating women Helping women live in facilities Doing quality antenatal care and the whole package. So we have in fact on We training the staff providing with basic skills. For instance, the images obstetrical and neonatal care I've also been able to provide a training For the helping baby's growth which is focused on resuscitation of the newborn. The training has helped me In so many ways in that supposing a woman comes in labor. I know what to do And if there's any complication I know how to go about it in order to help this woman and probably save her life as well as the babies Almost all these initiatives are related to the setting mothers giving lessons Russian partners are very important because of a country we will not be able to meet all these obligations without International support. The partnership with the US government is important to Zambia Because we started a long journey and we can't do it alone. It's very very costly and we need the support From the US government so that every woman can look forward to labor And not say I may die. I'm hoping That these programs should not come to an end and that they should continue when a mother dies in a community It's really sad. It's a sad situation. If a woman dies The nation dies with that woman Because the nation starts from the family and we know that the woman in Zambia is the one who provides In a lot of respects What I've heard from the women is that When they deliver They go back home confident that they have a healthy baby and their lives were handled by um Professionals they know that even when they get pregnant next time, they'll be given the best of care Sorry, I'm going to invite the panel to come up now And while they are coming up to the stage all of you please I'd like to acknowledge a couple of important Partners first of all the gates foundation which has been hugely supportive of our work here at the global health policy center And I believe julie bernstein and tom walsher are here So we're glad you could you could come today and we want to acknowledge the global health and development course from gw Vic barbieros class. They're back here. We're glad you could come And I will introduce everyone First and then we will we will all We'll go down the line given the shortness of time and the Desire to open this up for questions. We're really going to keep this to five minute short presentations And as moderator I will use my prerogative to make sure they understand that But we are delighted that such an incredible panel has been able to gather here today I Will start we're going to start with christie turlington burns Who is the founder of every mother counts a campaign to end preventable deaths caused by pregnancy and childbirth around the world Every mother informs engages and mobilizes new audiences to take action to improve the health and well-being of girls and women worldwide In 2010 christie directed and produced no woman. No cry a documentary film about the global state of maternal health She is an advisor to the harvard medical school global health council and the harvard school of public health board of dean's advisors Every mother every day and the white ribbon alliance christie Good afternoon everybody It's a pleasure to be here and to participate in such a wonderful panel So I became a maternal health advocate when I became a mom I actually experienced and survived one of the complications that is the leading cause of maternal mortality around the world And that experience and the knowledge of the deaths that were taking place at the time of that Of my first delivery were what got me to engage On this issue and at that time in 2003 The global maternal mortality statistics were at half a million plus women dying each year That number has come down significantly But it was the the fact that 90 of those deaths were preventable that got me excited and want to engage I then traveled with The ngo care to a number of countries and one of the the experiences that I had that really got me excited and Moved me to make no woman. No cry was a program in in Peru which reduced maternal mortality in half in five years and seeing how they were able to do that um It was something that I thought was So doable when I left seeing this femi project in in iacuccio and I came home I decided to make the film I traveled around the world for two years traveling to four continents to look at those barriers That women face each and every day when trying to access maternity care at the critical moments And so it was really with that experience and and what I saw and learned on that trip or those many trips to make the film that Got me to want to start every mother counts I thought if I could inspire other people like myself who were connected to this issue Based on the experience of becoming mothers themselves or washing loved ones go through the experience and get the care that they needed at that time That we could do something about this that we could actually really make a significant impact on these global numbers um So that's why I got excited when we were invited to the table when saving mother's giving life was was being formed and Three of our colleagues are here on julie and claudia and selena Um To sit down and hear about these ambitious goals. I thought wow if we can do this This will inspire so many more people like myself every day American citizens who once they learn the facts they want to get involved and they want to engage and they want to be a part of of creating um possibility and outcomes and then the idea that made such good sense to build on existing Infrastructure and platforms through pep far in the two countries where where we're focused That just really inspired me got me excited and wanted me to wanted me to Inspired me to really want to engage and share what I was learning through seeing these positive outcomes and these success stories To share that with the american public to get to get more involvement. So I welcome Sitting here at this panel and having a deeper discussion, but thank you so much our Next speaker is christie micas from the pep far coordinator from zambia who just arrived at yesterday She has been the pep far coordinator in zambia since 2008 Before her current position. She was a special assistant and southern africa team leader in the office Of the director of foreign assistance at the state department And before that she was with ogak where she began working with pep far when the office was first created in 2004 christie Thanks janet. Good afternoon everyone Thank you so much for coming to today's discussion and a huge thanks to csis for putting on Not only today's discussion, but also these remarkable videos And I was with I had the the pleasure of being with janet and their team members when they came to zambia to film the videos And I can attest to the fact that they really Are concerned with not only the the health of these women, but that we have approaches that are sustainable They're not afraid to ask the hard questions. And so janet. I just want to thank you So much for for hosting all of us today Um, so today I wanted to talk to everyone about how we are able to leverage The pep far platform for broader gains in women's health and in zambia in particular PEP far as you know is the president's emergency plan for AIDS relief And in zambia we're working in a country that is It's a landlocked country with eight international borders And a population of about 13.7 million people The hiv prevalence rate in zambia is about 12 and a half percent And as many of you know AIDS disproportionately affects women and about 16 percent of women in zambia are infected with the virus And also we know that the rates in the urban areas are much higher. They're closer to 20 percent Of people infected with hiv and about 10 percent in the rural areas. So it's certainly been a big problem in zambia So the the pep far program in zambia is a 306 million dollar a year program Of bilateral support. So it's there's been about 1.9 billion dollars provided to zambia Since its inception and there's an additional billion dollars of global fund Money for zambia. So there's a tremendous amount of funding For to fight hiv aids in zambia and there's a strong track record of success zambia is one of the secretary former secretary clinton's blueprint country blueprint countries For how for the different mix of interventions that could really be a turning point for achieving an AIDS free generation So zambia is one of those countries where we have the potential to really get it right And really see an AIDS free generation Zambia also benefits from many central initiatives There are a lot of central initiatives out of washington out of ogach and many of the different usg agencies That zambia is very fortunate to benefit from as well as public private partnerships And we're i'm going to talk briefly about two of them today So in pep far the hiv aids prevention Care and treatment health systems strengthening programs are implemented by five u.s. government agencies and 100 partners Just very briefly the scale-up of treatment in zambia I think is the reason why we can now have some of these discussions here today about maternal mortality And even women's cancers in zambia because in 2004 before pep far began fewer than 3500 people were accessing life-saving arvs There were funerals every weekend. I mean it really just everything kind of came to a halt And now we see that nearly half of a million of zambians are accessing life-saving treatment Which has just made a huge difference This is one component of pep far, but we also Have seen tremendous gains in preventing mother-child transmission for example where we had again fewer than Two or three thousand accessing prevention of mother-child transmission services in 2004 and now over 600 000 women benefiting from those services So we couldn't be happier with the results Of our pmtct and our hiv efforts and about 85 percent of mothers are linked to treatment In some form or fashion. So we really see a lot of the women who are showing up to access those services So we're able to build on some of these investments that we've made in pep far in a couple of different partnerships One of them is saving mothers giving life, which we're hearing about today But also pink ribbon red ribbon, which you may not know much about but i'll talk about that just for a moment And then there are additional opportunities in family planning and hiv program integration You know pep far has saved Millions of lives as we just heard secretary sabilius mentioned But they did this but pep far was able to do this by providing training By building lab systems and capacity by providing monitoring and evaluation to ensure good quality It's not just about the numbers but also about quality and investing in programs to ensure a safe blood supply To ensure an adequate supply of medicines the supply chain itself And in some cases providing infrastructure So with these investments, that's what we're calling the pep far platform It gives us a chance now to make sure that we are addressing other concerns that That affect women in the global health context. So briefly i'll talk about pink ribbon red ribbon This is the initiative that has been started by four different organizations George w. Bush institute una's susan g come in for the cure and the united states government are the four founding partners And the reality is that cervical cancer is the leading cause of cancer mortality in africa And zambia has the second highest cervical cancer incidence globally This became a big issue for us in zambia working with the government of zambia Because women who are hiv infected are four to six times more likely To have cervical cancer than women who are unaffected So we were seeing this is this is a problem for women who are hiv infected And unlike in the states or in other parts of the world where you see women who have cervical cancer in their 40s 50s 60s In in zambia. We see women in their 20s with cervical cancer. I mean it was really something that we couldn't ignore So the pink ribbon red ribbon there are four or five different Depending depending on how we classify them interventions. First, we have primary primary prevention of cervical cancer Which is the hpv vaccine. We also have secondary prevention primarily through screening and treatment And then we all the palliative care portion. We would consider that part of pink ribbon red ribbon pep far zambia through Through washington is providing direct financial support to to provide services to these women for the secondary prevention component We're increasing our test and treat services But everything that we have invested in in pep far So if I had a slide you'd be able to see a little bit easier But in terms of awareness advocacy and mobilization the policy environment Infrastructure human resources for health lab systems equipment supply chains safe blood I mean all of these all of these different areas that we've already invested is sort of weave throughout the different different interventions for cervical cancer and make a A scale up of a cervical cancer program like this Not that difficult. I mean it's everything is difficult, but It's funding either on the margins or sometimes no funding at all needed. It's really just tweaking what we've already invested in So it's really an incredible opportunity I won't say too much about saving mother's giving life because we'll have plenty of opportunities to talk about that um, but I just want to say that About one in 37 women in zambia In particular will die of while giving birth and we know that the majority of these deaths are preventable And so we already know that 85 percent of women are accessing mother-child transmission 94 percent are accessing Antenatal care at least one point in their life And so we're getting the women in they want the services We just have to make sure that we make the most of that So again saving mother's giving life is building from Strengthen the supply chain different advances that we have at the facilities transportation of pregnant women blood supply everything we're investing in for For pep far are things that benefit women and children in zambia Going quickly. I've been given the warning that I have less than a minute now So with if I can just say just 30 seconds about family planning and HIV programming integration Zambia has one of the highest fertility rates in the world an average of 6.3 children per women live births And so we also see that 98 percent of of people know about contraception But 80 percent of women are not asking about family planning at a facility level or with health care workers in the field We know they're coming in to prevent mother-child transmission. We know they're coming in to access antenatal care It's a missed opportunity if we then don't do a little extra to talk to them about family planning services If they want them And so I think really the the takeaway message is that we've done so much in HIV is with pep far And we're doing a lot more now with saving mothers and with pink ribbon red ribbon for cervical cancer With just a little bit extra on the margins and some of it doesn't even require funding I think we can have even a greater impact on women's health in zambia and around the world So with that, thank you so much for your attention Sorry, thanks very much. We're going to now turn to k warren The co-founder of the saddleback church in lake forest california with her husband rick And the founder of the hiv and aids initiative at saddleback She's a bible teacher author and international speaker k frequently travels the globe to encourage men women and children living with hiv and aids as well as vulnerable children And today she's a powerful voice on their behalf Her latest book choose joy because happiness isn't enough was published in 2012. Okay Push the button moment first. It's a pleasure to be with you to join this vital conversation about women and girls Saddleback's peace plan has been active in rwanda since 2005 And in partnership with the churches of rwanda and in many instances the government of rwanda We've collaborated around hiv and aids orphan care poverty reduction illiteracy clean water Land grabbing training community health care workers leadership development and church health And more recently we've expanded our efforts to include three more issues that directly affect women's health And well-being the first is around hpv More than 135,000 12 to 15 year old girls have been vaccinated against hpv in rwanda in the last two years through the pink ribbon red ribbon initiative And in the churches we partner with we encourage the pastors to promote the hpv vaccination Because the vaccine is new to rwanda We have witnessed the ongoing suspicion of western vaccinations As well as fear related to a sexually transmitted disease fear of a vaccine related to a sexually transmitted disease But the pastors who are at the community level They can be legitimizers a trusted source of information in every congregation who can dispel myths and stigma Many of these rural congregations are very conservative But the pastors can say things like there are medical things that we must do to protect our daughters Against diseases that may come from others and there is nothing that contradicts scripture That may seem alien in our culture, but in a conservative rural community Those are the messages that pastors can give And so pastors become allies powerful allies for better health for the women and the girls in their congregation Then economic empowerment Since 2008 more than 300 savings groups have been established through local churches Each particular savings group sets its own rules and standards for participation Most require a seed donation of about 5 000 rwandan francs Which is the equivalent of three us dollars, but it varies with the group And then the group decides how they want to use these shared savings Some groups decide that this month one woman will receive all of the money And then the next month another woman will receive all of the savings Some decide to pool the savings and start a business or an enterprise together It is it is an incredible wealth creation vehicle for very rural women who live in extreme poverty Since 2008 this group these groups have saved one million us dollars Gender-based violence is an area in which we have begun to speak with the churches Through a program called the clinical church the rwandan pastors have been exposed to training on gender-based violence Just last week a presentation was made by the cdc to my colleague and 20 lay social workers that she was training The the statistics were shocking and sobering And perhaps some of you already know the horrible statistic that i'm about to share But according to a world health organization report Among women aged 15 to 44 gender violence accounts for more death and disability than cancer malaria Traffic injuries and war put together The news about gender-based violence is devastating and it rips at all of our hearts But just as the faith community can be helpful in passing on correct messages about vaccinations Provide pathways for wealth creation for the poorest of the poor The faith community can also play a significant role in eliminating gender-based violence Each of the seven strategies identified by who's violence prevention the evidence Falls within the scope of the church's purview in one way or the other The seven preventions are Seven evidences are developing safe and stable and nurturing relationships between children and their parents and caregivers That's a role the church can play as they teach families what it means how to parent providing preschools for children The second is to develop life skills in children and adolescents again The church has a role to play in providing training for children and adolescents The third is reducing availability and harmful use of alcohol Well, the church commonly has a message about alcohol control, but there's also programs of recovery where Those who are struggling with alcohol addiction are able to find Relief from the addiction and to find a new way of living Reducing access to guns and knives promoting gender equality to prevent violence against women Changing cultural and social norms that support violence and victim identification care and support programs All of these fall within the sweet spot of the church These are messages that churches can give to their congregations of the roles of equality between men and women Of honoring and valuing children and boys and girls Last week in rwanda pastors gathered to share what they were doing to eliminate gender-based violence One pastor said That he used to preach that women needed to endure beatings when her husband if a woman's husband was drunk He used to tell them that they should endure that because that was her role as a wife But with one training on gender-based violence last year He changed his mind entirely Met with his denominational leaders and now has a program in his church That includes volunteers who go as a group to confront men who are threatening to harm women and children They now report abuse to the authorities Bring violence out into the open in the community and have created a safe place for women to go in the community to find safety In an emergency Imagine what could happen Countrywide with more than just one training one training made such an amazing difference in one pastor Imagine the cultural mores that could be changed with more training We are grateful for the strong communities of faith in rwanda that promote better health for women and girls. Thank you Thank you k our last speaker for this part of the panel is going to be dr. Phil neiberg A board certified pediatrician with additional training in infectious disease Preventive medicine and public health and with service as a u.s. Military physician Phil served as a medical epidemiologist in various programs for the cdc And since 2003 he has been a senior associate here with the global health policy center Phil Thank you janet Good afternoon everyone Janet asked me to to talk about the impact of family planning or the lack of it on on maternal mortality and other key women's health indicators So i'd like to start by reflecting for a minute on on millennium development goal number five Which is not just about preventing maternal deaths Millennium development goal number five is actually titled to improve maternal health And there are two targets for the goal one is to reduce maternal mortality, which we hear a lot about And the second target is to achieve universal access to reproductive health, which we don't hear a lot about Of the six indicators for that that mdg The three that are almost never mentioned are The contraceptive prevalence rate in countries the unmet need for family planning and the adolescent birth rate So each of these indicators are directly related to women's access to family planning information and services the second point second reflection point is about Intermittent partner violence or gender-based violence And you just heard k warren give some of the statistics on this pregnancy related deaths related to violence Such as homicide are not included in maternal mortality estimates In fact, they're specifically ex excluded by the death of the current definition Which talks about Any death of a woman while pregnant related to pregnancy? But at the end says specifically Not from accidental or incidental causes and so currently deaths due to homicide or suicide that are pregnancy related are not counted And the third point is maternal morbidity Which is non-fatal outcomes Many women who survive pregnancy complications are left with severe permanent physical or emotional or social disabilities Such as infertility, prolapse, uterus, obstetric fistula and injuries from pregnancy related violence And those morbidity Serious morbidity is 15 to 30 times as common as mortality And there's an excellent review of this this topic by Karen Hardy, Jill Gay and Ann Blank in the journal global public health from last last summer for any of you who Want to read about it Specifically in terms of maternal mortality The direct causes we heard a little bit about but there are Eclampsia Prolonged or obstructed labor Postpartum hemorrhage infection and unsafe abortion Those are the direct causes that is result directly from complications of pregnancy the indirect cause those account for about 80 percent of all maternal deaths There are a number of indirect causes related to diseases like malaria or hiv But remember these causes of deaths are Are decided using the medical model and and secretary Sibelius talked about What she said I think was the social barriers that prevent She talked about the social barriers that prevent women from getting the care that they need And there are a number of social issues underlying social and economic causes of A Maternal mortality that that are not being directly addressed at the moment. We're not being sufficiently addressed at the moment So it's worth keeping in mind that Family planning can reduce the numbers of maternal deaths in at least four ways first Remember there are about 15 percent of women who develop who are pregnant develop unanticipated complications And reducing the number of pregnancies will reduce those unexpected complications resulting in death and therefore the number of women with severe complications as well But severe but non-fatal complications second delaying first pregnancies until after adolescence Sorry means that fewer women will have prolonged or obstructed labors because of their immature pelvic structures Third because most unsafe abortions occur in unplanned pregnancies Having fewer unplanned pregnancies will mean fewer unsafe abortions fewer abortions overall And so therefore fewer maternal deaths and the fourth Family planning the fourth relates to the fact that women With five or more pregnancies are At a greater risk of death during pregnancy than women with fewer And so having fewer unplanned pregnancies in those multiparous that is how repeatedly pregnant women means that fewer pregnancies among those Women will result in death There's a great paper in the Lancet last summer that talked about that used data from 167 countries and And indicated that the global that satisfying the global unmet need for family planning would result in A rapid 29 reduction in global maternal mortality And I should also point out finally that that Access to family planning also has child survival benefits. So if fewer mothers die fewer motherless children Will die those and those children have high mortality rates and fewer unplanned pregnancies means better birth spacing and therefore Children who are who are spaced Appropriately have a lower child mortality rates. So I think I'll stop at that point. Thank you So before we turn to Karla who will be our last speaker and then we'll open it up to questions We have one more video to show you which has been referred to in Christy Micas's remarks This one our final video looks at the integration of services for cervical cancer and hiv As she mentioned cervical cancer kills an estimated 275,000 women every year 85 percent of whom are in developing countries The link between hiv and cervical cancer in women is direct and deadly HIV positive women infected with certain types of hpv are four to five times more susceptible to cervical cancer than hiv negative women So to understand the opportunities and challenges of integrating these services We travel to zambia which has been at the forefront of integrating these services As christy noted the attention to this issue has been heightened with the december 2011 launch of the pink ribbon red ribbon initiative in zambia And that pink ribbon red ribbon is designed to build off the hiv services supported by pep far The zambian government is also very engaged in pink ribbon red ribbon led by the first lady dr. christine keseba sata who is herself an obstetrician and gynecologist Through the voices of these hiv positive women who are now accessing cervical cancer screening And the health care workers who are trained to screen and treatment treat them This video underscores the importance of integrating these services to save women's lives I went for cervical cancer screening because we know that People living with hiv the immune system is low So they are likely to have any disease which comes I was one of them who thought that I should go for this cervical cancer test And I was found with pre cancer What used to happen was most of the attention was Drawn to hiv So interventions were introduced ARVs were introduced women were able to access the ARVs But would still find that despite them accessing the ARVs and all the services that come with the ART clinic They were still dying from cervical cancer So imagine you treat somebody and put them on treatment for life And yet they succumb to cancer of the cervix because you didn't manage it So that is why it is extremely important That we manage the two The the pink ribbon red ribbon program Is a program that is trying to integrate hiv and cervical cancer services And we have benefited from that program. We're now able to screen women Especially those who are hiv positive for cervical cancer A lot of women have started coming in for the services this year We think because there's been a lot of awareness that has been created Starting with our women leaders in this country, including the first lady President Bush's visits also created quite an amount of awareness Because immediately after his visits we saw that the turnout in our clinics was very high I remember about President Bush's visit when I was passing going to town I just saw a lot of cars were packed outside So I said what is happening here? They said that President Bush has come to open the clinic for cervical cancer The first lady, Dr. Cassava Sata, she talks about this about Encouraging women going for screening for cervical cancer So I said the time I'll go back to carway I'll go to do the screening When a woman walks into our screening services This woman is also asked about her hiv status If she knows it, if she doesn't know it and she's never been tested We also offer counselling and testing for hiv to this woman Then the nurses will carry out a procedure called visual inspection with ascetic acid Which is just vinegar They'll soak the cervix for roughly about five minutes To be able to identify precancerous lesions If the lesion that is found is quite small They use cryotherapy using nitrous oxide gas And they freeze off the abnormal lesions However, if the lesion is quite large They'll refer the client to carway general hospital When I was told that of this precancer me I thought that that was the aid of me But I was told that no When we find you with this precancer It's curable I would say the major challenge that we have right now is the staffing The entire province only has five people who are trained And yet as you've heard we have screened over a thousand women in the five months So there are times when it could be quite overwhelming I think that both this government as well as the United States government Have agreed that the resources need to be found We need to make sure that not only Lusaka But that every woman can have this service done wherever they are And that will require a lot of training A lot of equipment and a lot of resources But I am very hopeful that through this Within the next four or five years I think we should see cancer of the cervix going on the decline By offering these services that I'm giving to these women I feel that I'm improving their life Because I get assured that this woman has a little longer to live Other than her dying from cervical cancer Yes, we are happy to have these services ART services and cancer screening Because it's helping the women in the community and from other communities I went for treatment and now I'm feeling fine And I'm very sure that I've been cured So now for our last speaker We're going to turn to Karla Kopel Who is USAID's senior coordinator for gender equality and women's empowerment And a senior advisor to the USAID administrator In this role she spearheads the advancement of U.S. development assistance efforts To serve and empower women around the world And to ensure that programs are designed and implemented in a gender sensitive manner Karla Thanks so much. Good afternoon I want to first congratulate CSIS Steve Janet on the report on this event I think it's tremendously important that we frame where we've gotten to And where we need to go When we were talking about what I should say Basically Janet said well you know what have you done for me lately? Not literally but she said you know we know all that's happened We're all about business and progress So maybe you can tell us about what's to come And what we're doing to move this forward And that's a I have to say that's a very comfortable space for me to speak from Because I really am all about moving forward And as Secretary Sebelius said All of this only matters the framework the strategies The vision and the rhetoric If it makes a difference for people on the ground And the people we've heard about in the video So where are we focused? Well USAID is really focused on two things Implementation of policies and strategies Some of which have been referred to over the course of today And institutionalization of these commitments So that they endure for the long term We have now a comprehensive strategy A set of strategies and policies And as we move forward to implement those One of the things that came about recently Was a presidential executive order that institutionalized Permanently both the position of ambassador for global women's issues At the State Department As well as my position within the office of the administrator at USAID And we hope that by creating By putting in place that presidential order Or I guess it was a presidential memorandum What we know to be the case now That having that representation at the top That viewing a commitment to gender equality And women's empowerment as transformative In delivering for US foreign policy And for delivering on the ground Will stick and will stay for the foreseeable future If I then turn and think a bit about what we're doing To move our policies and strategies forward within USAID I would point to very concrete things That we've done since that policy was released And it's almost exactly I think it's almost exactly one year ago That the gender equality and female empowerment policy was released We've trained over 500 professional staff In different sectors And we're developing online training To fulfill the mandatory requirement That everyone received training On how to reflect gender equality and female empowerment In our work around the world The majority of our field offices Which are called missions Have in place what we call mission orders Which are mandatory under our policy And call for really enumerating How they're going to roll this out operationally Within their structure and the structure of their missions We now have focal points or gender advisers In almost every operating unit around the world And in Washington DC to look at this issue To have the training and development to be able to provide The technical assistance to other staff And to operationalize our policies and programs We've put in place nine indicators agency-wide Five of which will be mandatory as applicable To measure the results of our programs To see where things are working Where there need to be improvements And where there are challenges that still remain to be put in place And to make sure that we're taking care of the The men and women within the agency itself We've created something called Women at Aid Which is a new affinity group On how we ensure that our work environment Is one that is conducive to success And in fact next week are organizing an event on men And work family and work life balance To ensure that we're really dealing with gender issues Within USAID itself So that's the institution And how we're moving the policy forward And I have to say that the uptake and the adoption And the willingness of people to embrace All that we're doing and move this agenda forward Has been very, very rewarding People don't say why They say give me the tools to do it And how can I move this agenda forward And that's incredibly important If I telescope in for a minute Into the issue of gender-based violence You heard from Secretary Sebelius That we now have a national strategy On preventing and combating gender-based violence globally What that's meant for us within USAID Is the establishment of a gender-based violence Steering committee Which is actually composed of program officers Rather than the people who are in Our gender-based violence working group Which also exists Because what we want to make sure Is that as we push integration of attention To gender-based violence in our work It's something that is really owned By people who work across all sectors And not simply those that are focused On gender-based violence We're also developing criteria For identifying where we should prioritize In part based on prevalence But in part where we can really make A difference moving forward And we've created and are rolling out An incentive fund for providing support To add and integrate components Related to preventing and combating Gender-based violence As part of sector programs In a range of different areas So that we really are appreciating How we can achieve a multiplicity of goals Through a variety of programs In different places We've also started to more forcefully Move forward a research agenda So on the gender-based violence In the gender-based violence field For example, that involves creating analysis To look at how men and boys Can best be brought in to help us In preventing and combating gender-based violence And I think Kay Warren's comments About faith leaders and their role Is incredibly important We are examining the association Between women's economic empowerment And experience of gender-based violence Because we know that women's economic empowerment Can have positive or negative consequences For gender-based violence And we want to make sure we're getting it right And that that economic empowerment Is reducing gender-based violence We're identifying successful intervention programs That are scalable And we're looking across the relief To development continuum Where there's conflict and natural disaster To see how we can bridge those gaps And make sure that gender-based violence Isn't an unintended consequence Of the process of recovery Those studies are complemented by efforts through For example, PEPFAR funded Randomized control trials That are looking in Tanzania At prevention and services on gender-based violence And the uptake of services And other HIV-related behaviors That's one area But really the range of efforts That we're talking about Related to both the building of partnerships And the integration of attention To women's health concerns writ large And the range of women's health concerns Into programs across the board Stretches out broadly And I know my time is up But I want to give you a couple of other examples Beyond GBV Just so that you're aware that they exist In work around family planning and HIV aids We're working on in Mozambique On funding strengthening communities Through integrated programming project Which is integrating health, HIV, water sanitation And rural enterprise programming Through an AFIA program We're working in Kenya With the Kenyan Ministry of Health And partners to accelerate implementation Of various integration models That link HIV interventions With other elements of reproductive health And then there are a whole variety Of broad partnerships Related to post-partum family planning That are underway in a range of countries Including in Bangladesh And several sub-Saharan African nations That I'd be happy to speak to This past year AID's family planning programs Reached more than 84 million women And averted 21 million unintended pregnancies This helped to prevent 15,000 maternal deaths And save the lives of more than 230,000 infants We're exceptionally proud of those accomplishments And yet we recognize that there's a lot more That we can do Through the integration cross-fertilization And promulgation of partnerships Shaped based on an increased knowledge Awareness and ability of our staff Experts and the experts In our partner organizations To think about these issues holistically And move partnerships like we've heard about today Forward I look forward to the questions in the conversation I hope that fits the bill in terms of what comes next And how we're moving forward We are eager, eager, eager To maximize the results for development In all that we do Through our commitment to gender equality And women's empowerment So thank you All the panelists I think you'll agree that they did an extraordinary job Especially in a very short time frame To give us a taste of some of the extraordinary work That they're doing And the way that their work complements each other I mean it's a great opportunity for us In a policy audience here To be able to hear about all the interesting And important efforts being done And to find ways that we can be finding the synergies That are important to be able to bring These issues to the fore To continue to prioritize women's health And gender equality In the different spaces where we operate So that we can together have a more priority focus On all these issues And to encourage the Obama administration In its second term To maintain this as a priority area We were lucky enough to have a working group That helped advise the chapter That you got when you came in A range of people in the Washington area Who are active in many different parts of this community And I think it's a testament to the fact that This is an issue This is an area where there is a lot of bipartisan consensus There's a lot of different groups That are working on this And we need to continue to work together To bring these issues forward And provide the evidence from the ground Of what's working And how we can better find synergies together Before we open it up to questions I want to use my prerogative to ask a couple Just to start it off And I think maybe since we just ended With the call to partnerships Maybe I could ask Christy Turlington-Burns To talk a little bit about the partnership In saving mothers' giving life And your role in that as the NGO partner And what we might see as going forward Well, as I think was sort of appeared up on the video The partners that were the initial founding Members were ACOG The American College of Obigine Merck for Mothers The USG The Government of Norway And ourselves And there's a new partner that's just come on board Which is CURE An NGO that we hope to help us In terms of supplies and getting needed supplies Into both of those countries As well as as we get into phase two Of this initiative I think for us or why we were brought in Was that idea of being a public interface To sort of share some of the successes That we believe will come out of this We've already seen a tremendous amount of success On the ground and we were in Uganda in November And some of the team was also in Zambia at that time And planning to return in a few weeks And what we were able to see in such a short time Was just incredibly inspiring On paper This looked like this is gonna happen But when you actually get on the ground And you see the coordination And you see the amount of pride and leadership At the village level Every staff was so energized As they were reading through their documents Of maternal deaths that took place Just six months ago on a monthly basis Versus this month and last Where sometimes in facilities it was just zero deaths I mean this was just a tremendous thing To witness and to see the excitement generated What was accomplished when those goals Were put up and the challenge was Was presented So yes, very exciting And then just one question to Kristi Micas Who gets the award for having traveled far this to get here There's been a lot of talk recently About global health diplomacy And obviously a lot of your work in Zambia Is a reflection of how the work on global health Can be brought to a new level But I wonder if you could explain to us The importance of the women and girls And gender equality piece of global health diplomacy From your vantage point in Zambia Thank you so much Well I think with global health diplomacy At least in the Zambia context It's been sort of a natural progression From working on such a large program Like PEPFAR And then using that space to branch out into other areas You had mentioned Janet The leadership of the first lady of Zambia Dr. Kristine Kasebasata And I think that there's no better Example of a leader for a country I mean she's the first lady so that alone But she's such an advocate And an OBGYN herself I mean the message that she conveys to women and girls Is something that no matter how hard I try Working in the embassy I could not convey to the average Zambian woman or child So working I think with leadership in Zambia Is a huge global health diplomacy lesson for all of us Not just the first lady But the minister of health The minister of community development Mother child health People like professor Elwin Chomba Who you saw on the video Who's a neonatologist by trade I mean she's a brilliant, brilliant woman And just the talent that we have Around the table for these different areas I think also the benefit of public private partnerships Is just absolutely tremendous Because there are rules of what all of our organizations Can do especially in the US government Of what our funds can be used for Not partners don't have Independent partners don't have a lot of those rules And restrictions So they can come in and compliment a lot of what we're doing For women and girls in particular We heard a lot about the USA strategies And we work as one mission at the country level And so partners can come in And we can also use the more voices the better The more people who are coming to the table At the leadership level in country Private sector partners and NGOs and other organizations I think all the better for the women and girls in Zambia And around the world So just before I open it up to the rest of you I'm going to look for Jen Katez Who's going to just come and say a word We have a mic coming toward you Jen was involved in the IOM study That was just released on PEPFAR And is going to say a couple of words About the gender components of that study Sure Thanks, thanks Janet And thanks to everyone on the panel This was great As Janet mentioned I had the honor of being on the IOM Evaluation of PEPFAR It was released two weeks ago And it was a congressionally mandated evaluation As part of that Congress asked us to look at Gender aspects of HIV And what PEPFAR was doing to address them Including men and boys And we have a whole chapter on this It's probably a very extensive look And I'll just say a couple of take home messages That we felt as a committee That the program really had evolved In how it thought about gender And the approach it took And scaled up more over time But that there's still In general the response was still ad hoc In many ways and needed You could benefit from more focused scale up And also a big thing And this I don't think is unique to PEPFAR That the PEPFAR isn't yet measuring Or putting out objectives Clear objectives for how it's going to assess The impact and providing guidance to the field And how to prioritize And how to really make a difference So that was our big recommendation But there's a lot of the information That you shared We tried to address What PEPFAR was doing around it So thanks Thanks very much We're going to open it up to Q&A now And I hope this will be an opportunity To ask some of the questions About these opportunities And the challenges ahead And ways we can really prioritize These issues going forward So over here on the right We'll start We'll have mics coming to you And please identify yourself In your organization When you begin to speak Thank you My name is Suzanne Alerzon With Population Action International And first thanks to CSIS And to Janet especially I was a member of the working group For this paper And I'm really proud of What it says and what it charges us with Moving forward in this second administration I'm just coming from a lunch And celebrating International Women's Day Where we were exploring The sort of posity of the research base For the ways in which Women's economic empowerment Can really be multiplier investments for nations And so I'm thinking of My own beloved issue Family planning and reproductive health And how we know that a dollar invested In family planning Can literally leverage Six, seven, eight dollars In different countries In terms of the whole development arena So in this time of sequestration Can we hear a little bit From some of the panelists About how much more key Those kinds of cost effectiveness arguments Are going to be moving forward To really make the case For investments in sort of the F-150 account For global health more generally And then of course for the issues That touch the lives of women And girls most closely Why don't we take three questions And then we'll turn to the panel So I don't want to ignore over here So over in the red shirt over here Hi, thank you. I'm Dr. Hannah Claus. I'm a gynecologist. I just finished a PEPFAR grant. I'm delighted with all the things That you're doing And I'd like to just point out That women who have been treated For cervical cancer at once Are still at risk. I was troubled by the fact That this young woman said I'm cured. As long as she has Human papillomavirus in her body She's not cured. And also what are you doing About the men And also PEPFAR strategic objective To I think it is be faithful Which I think would help In preventing transmission. Thank you. One more question And then we'll open it up. Yeah, in the vein of sequestration Are there any strategies or initiatives That the government is putting forward To empower more faith-based Organizations to take a more active Or leading role? Okay. The first question on resources. Carla, do you want to take that one? I think that research and that database Are absolutely essential. I mean, there's an incredibly important Rights-based case, Philosophical and moral case To be made for investments In all of these areas. But part of my job is Selling this agenda to a variety of audiences Using a variety of tools. And there's a solid constituency For the data that indicates Why investments in women's economic empowerment Women's health, combating gender-based violence Is it makes economic sense Makes sense from a development perspective Apart from the other compelling reasons Why that's true. And as we've developed strategies and policies And really looked at the evidence To make sure that it was completely reliable That we could count on the data And the numbers we've recognized Increasingly how little there is Of that kind of research That really holds up to scrutiny And that we feel that we can stand behind So that quantification is incredibly important And it's incredibly important Not just for the purpose of making the case But also for designing and implementing And evaluating interventions for maximal effectiveness Kay, would you like to take the question On the faith-based organizations? Well, there will just never be enough dollars The fact is there will just never be enough dollars There will never be enough professionals And so the faith community can step in In ways that the government never can The government has to do what it can Governments both globally and then what the USG But then the role of the faith community Is to fill in those gaps And do what only the faith community can do The faith community has about 2.3 billion people Who claim to be a part of it And so there are volunteers sitting in every congregation In every temple and every mosque around the world And so when those volunteers are mobilized They can take the place, fill in the gaps Where a grant could run out A grant might not be given again And still the need exists in a community But when the faith community is utilized When it's mobilized Just like we've trained 7,000 healthcare volunteer Healthcare workers in Rwanda Who are delivering primary care to about 80,000 They make about 80,000 home visits a year Each healthcare worker has seven clients Well, that goes beyond what the government can do And these are complete volunteers So there is a place for lay social workers There is a place for that task shifting That can not even just go to nurses Even in HIV care But to those who are trained volunteers in churches So this is definitely a moment from my perspective For the faith community to not be discouraged in any way But to actually look for vital ways To participate in global help And on the cervical cancer piece Phil or Christy, do you want to take that? I can make a comment I have not been involved with the HPV work In developing countries But one thought is about what's happened in the United States Additionally, the focus in the U.S. Was giving the vaccine to HPV vaccine To girls who are felt to be at risk That is protecting the individual Recently, there's been a shift to the concept Of protecting communities So more and more attention is being paid To the issue of vaccinating adolescent males As a way of reducing transmission And again, I'm not sure of how things are going In developing country programs So speaking to the question of how we get men involved In programs such as cervical cancer I think we look for every opportunity Certainly to involve men In the healthcare system Men in Zambia and many countries around the world Do not go to facilities the way that women do There are social and cultural reasons For that being the case But we recognize that And we try very hard to We're even looking at designing facilities So that they're man-friendly And that they're not just about antinatal care But that they're about comprehensive services We're looking at lots of different things But one of the key entry points for care Is HIV counseling and testing And so I think that we And even in cervical cancer We try to involve We try to encourage couples counseling testing Because it's a way to reach the men And they come in And once they know the results together They are more likely to follow a course of treatment If treatment is necessary It reduces gender-based violence incidents When they find out together and they learn together There's a whole host of reasons why that makes sense And so we're really trying to encourage men To come in at that level We also have programs such as Men as Partners In many different countries in which PEPFAR is working And these are explicit programs That are men talking with other men And again there's no better advocacy Than having national leadership Having a First Lady or a President Ministers of health coming out to say This is what's acceptable And this is what we expect And we want men to access these services So there's no substitute for that But around that we do everything we can To bring them in the doors That we can talk about health for the family Okay, we'll take another round of questions We'll start over here on the left The mic is coming Thank you very much We need you to speak into it for the webcast Yes, thank you very much I have a question regarding the role Of universal health coverage And the ways that any of your panelists Have considered how that might be used To help achieve health equity for women And particularly how these universal health programs Might help to achieve some of the priorities That you have outlined in your panel today Thank you very much And over here And again please identify yourselves Evelyn Chirot, CEO of Global Partners United And we're a public-private partnership Focused on technology applications So a two-part question One, have you used and congratulations On all these accomplishments Have you used technology, telehealth Or mobile health in the programs that you're designing So that there's greater reach And efficiencies And secondly there's a similar initiative To address the UN Convention On the rights of people with disabilities We know the prevalence of gender-based violence In the disability community We know there are 500 million women With disabilities, 80% in developing countries Who are really challenged To access health care services Such as the ones you've described We know that USAID has a very strong policy On disability program and infusion Into all the programs of USAID So if you could address that, I'd appreciate it Thank you And one more Thank you to the panelists I'm Mary Beth Hastings I'm with the Center for Health and Gender Equity It was a great presentation I just wanted to ask because I didn't really hear a lot About civil society And the role that women's groups play In particular in making sure That this implementation of all of these Wonderful policies that we've had Over the last four years That that implementation takes place With respect for human rights And that we're not just rolling things out Without truly knowing what the needs are on the ground And how the rollout is going In terms of feedback For example in terms of maternal health But it's not just skilled providers But how those skilled providers treat women Are they treating women with respect And with human rights that they deserve So just wondering about that Okay panel Does anyone want to take the first question On universal health coverage? A little bit far A field of what you're usually doing Okay, we have a volunteer I just want to state the obvious Which is that in countries where universal health care Is available There are a lot less maternal deaths I was in India last year With Julio Frank from the Harvard School of Public Health And he was giving a series of talks About universal health care in India And just seeing the history of the progression Of that in a number of countries And how those maternal mortality rates have come down So significantly is something that's In addition to a lot of other things It's worth taking a good hard look at Thank you Technology and disabilities Karla? Sure I think that we are in some cases using technology I think we're in the learning Still learning to some extent But a couple of examples One is we are using mobile technology Through the mama program A public-private partnership on transmitting information Through mobile phones about child and maternal health care And that's one application The other that we're working on now Is the use of GIS mapping And there are two ways in which That's significant Or is being used One is the use of the mapping technology To bring together all of the data That's out there to look at Prevalence rates And to be able to break that down To a greater degree of refinement So that we're So that we know where to program And where dollars Whether dollars are matched to priorities The second is understanding better Where from sort of gross numbers Where prevalence varies by location as well And just talking with folks About HIV AIDS infection rates in Kenya And the use of mapping technology Revealed that there were vast differences In terms of prevalence rates Among males and females When you looked by locality And so understanding those differences And using that as a tool for For figuring out how to put in place A gender-appropriate program Is going to be absolutely essential And I think the use of the mapping technologies Just speaks to a whole group of people That have trouble digesting information In other ways The picture really communicates a thousand words On the disability policy Really the work on gender equality And female empowerment writ large As part of a broader program Around inclusion and inclusive development And how you move an agenda forward That better integrates the voices And meets the needs of a wide range Of population groups So if you look at the range Of different framework documents You'll start to see a greater infusion Of attention to people with disabilities To members of LGBT communities Folks who are traditionally More affected by, for example Gender-based violence in certain ways Than the general population And what we're really trying to do Is make sure that there's a focus On not leaving out those subgroups Within those populations And I work a lot with Charlotte and Lapa McClain Who's our disabilities coordinator On thinking through these issues And how they come together And last week, for example, was speaking at the OAS With the Secretary of State for Disabilities From Haiti Who's been doing a lot of work with USAID On how to address the needs of the Much larger community of people With disabilities post-earthquake If I might also speak just to the Civil society question that came after I think it hasn't come out That much in the conversation But the role of women leaders In civil society is absolutely essential As partners in implementation As voices for people on the ground As advocates and as change agents And we've spoken much more about Women as beneficiaries And that tends to be a natural inclination When we're talking about health sector programs But women are really driving and making change And Secretary Sebelius mentioned this In her remarks when she talked about The women leaders within the health sector Our feeling is that they're essential partners In every stage of this process And that part of my job is really to Elevate the voices of women leaders For change within their own societies So that they can drive and make sure That these changes exist and endure And that's how we will really succeed Small anecdote unrelated to health per se But we asked our mission directors Which are the heads of our country offices To hold meetings with women peace builders So leaders in working for peace In societies around the world In conjunction with the first anniversary Of our national action plan On women peace and security And when we got back in the notes From those meetings that they had held It was, it's so reinforced The need to have these conversations With women on the ground Because they said, you know We held this conversation And here are the notes But they then went on to say All the things they learned In those conversations From having, having discussions With people they weren't usually talking with And it becomes really self-reinforcing And it's the kind of thing I really Look forward to seeing more and more of Just a small comment Not nearly on the vast scale is that But you asked about disabilities In, in our rural hospital in Kibuyi Rwanda there is, there's a physician In Minnesota who's disabled And he is an internist And he does rounds every day With the physician in Kibuyi by Skype So it's, it's been incredible on both sides Because here is a man who has been A physician all his life And has become disabled, unable to practice So from his bed, literally in his bed In extreme pain He does rounds every morning With a doctor that he is both mentoring And developing in Kibuyi Walks with him from bed to bed I mean by Skype Doing rounds every morning If I could just add a little bit To the question about how we're using technology In Zambia we are pioneering Electronic medical records Through a program called smart care And in the health programs And many of you who are working in health You'll know that we track lots of things Like loss to follow up And the amount of people who are accessing services And then they just sort of fall off We don't think that they've passed away necessarily But we don't know where they've moved to or what not So this is a very, this has been a big investment By the U.S. government And we see that the, that the Zambian government Is now interested in taking this up So that's an area if you're interested In looking a bit more about smart care For electronic medical records But also on the, just briefly On the civil society point This is something that at least in the Zambia context We work really hard to include civil society In all of our discussions Whether it's regarding our annual Country operational plan Or our partnership framework With the government of Zambia And we find that in Zambia The civil society actually use They've been using discussions With the U.S. government As a foot in the door To talking with very high level Representatives of the government of Zambia And we've been happy to help Create the space for that So there's more of a dialogue But we have some very active members Of civil society Our most active members of civil society Are those with disabilities And they're present in global fund discussions In PEPFAR discussions And they're vocal And they're passionate and powerful And so we are happy that they're Using us to get greater entree To decision makers at the country level Yeah, just a brief comment to follow On the technology and health issue In one of the open access journals In the last month or so There was a review article An interesting review article About evaluations of technology, health Programs And I was surprised to see that There was a paucity of data of outcome data There were lots of process outcome Process of evaluations But there was a paucity of actual outcome Or impact data from those kind of programs And the article closed with a strong plea To embed impact evaluations Into those kind of programs in the field I'm watching the clock So what I think we have to do now Is close off questions And give all our panelists a chance to Say some closing remarks Addressing perhaps some of the issues You didn't get a chance to talk about And looking forward to What are the next steps that you see In this space of the health for women and girls And gender equality Kristi, do you want to start off? Well, I just wanted to add one piece That I didn't say But a very important piece That is the importance of gathering evidence And data And at the moment Columbia University is doing some rigorous research To come up with some mid-year results That will be released in the next few weeks So please look at our website Or contact one of our colleagues Selena Schoak And probably the best one to reach out to For those updates We'll be excited to share that information With the rest of you Thank you I think just to highlight the value of Evidence-based interventions I think looking at We have so much data now That we didn't have even three years ago In the HIV context And in so many other contexts as well So just using the data to make better choices And better decisions when programming Resources Results sort of in the same vein Results speak for themselves People want to partner And they want to invest in programs That produce results So how do you tell the stories And how do you get the results And how do you communicate those results I think are very important And I think just the cost effectiveness issue Is huge And I think in the PEPFAR world We have been so blessed with so many resources And I think now the onus is really on us To really make sure that we're building From those investments where possible It's in no way to take money away from HIV-AIDS That's still the credit That's the very important That's what PEPFAR is all about But how do you leverage those investments And how can other funding streams be used To complement PEPFAR investments So that we can really do a lot more In this day of sequester We can't afford to not look at How to make the most of every dollar The government of Rwanda has put a huge emphasis On women, very intentional On women's equality and in the government And so the churches in Rwanda To be able to play catch-up In some ways with that emphasis On women and their value And to be able to speak about mothers And the critical role of mothers It seems redundant And one of those duh things But to actually focus on mothers And their role It's a privilege and it's an honor To be able to speak to the value of mothers And how important it is to keep them alive So that children have a mom and a dad As they grow up Just a couple of quick comments One is that I think the future programs Or plans of the U.S. government really Need to have a strong focus On non-fatal but severe outcomes Of maternal health problems Second, and to follow up To a couple of the earlier comments That the more support For improved data systems in countries The better Most countries still don't have Vital registration systems And that leads to ambiguity In data analyses And finally, the need to continue To strong the support And integrate family planning programs Into everything that the U.S. does Mine is a pretty simple one Hold us accountable And I know that part of this conversation And the report and the research Is related to that But hold us accountable for implementing it Make sure that we're driving these things forward Look for the staff, the resources, the programs And most importantly, look for the results Because that's how not only will we know We're doing what we said we did We were going to do But that also it's having the kinds of results We all think it will have But don't have the data to prove yet And really through that partnership Of mutual accountability We can really make an extraordinary difference I can't think of a better way to end this excellent panel Looking forward to the second administration And the different ways that all of us And all of you in this room Are going to be able to continue The important work that you're doing Continue the commitment that you have on these issues And hopefully we will all be able to Stay in touch and move this agenda forward In a productive way And hold the administration accountable For the next steps So thank you all so much for coming And thank you to the panel